Every day I experience life in the world of healthcare IT, supporting 3000 doctors, 18000 faculty, and 3 million patients. In this blog I record my experiences with infrastructure, applications, policies, management, and governance as well as muse on such topics such as reducing our carbon footprint, standardizing data in healthcare, and living life to its fullest.

Tuesday, May 18, 2010

Paper Kills

BIDMC implemented Computerized Provider Order Entry in 2001. As we approach the ten year anniversary of our implementation, it's great to see the recent press on the Stanford study demonstrating a 20% decrease in mortality after implementing CPOE at Lucile Packard Children’s Hospital.

The bottom line - of course bad software implemented poorly can cause new errors. Of course change in workflow can cause unintended consequences.

However, now that the industry has broad experience with electronic ordering (it's a meaningful use requirement for 2011), I think we can conclude that questioning the wisdom of implementing CPOE is like asking if a parachute works against gravity - I do not want to be in the control group of that clinical trial!

2 comments:

Great non-alarmist post on CPOE. In this debate on EHRs, we shouldn't loose sight of the fact the paper this tool replaces isn't the most reliable either; it is merely the form some people feel most comfortable (and thus, safer) with.

Upgrading to a newer tool should all be about how well such a transition can affect patient care, and thus the clinician's practice.

CPOE is a generic term. It is about as useful to say "drugs are good. We should use drugs to treat diseases." True, but we should use drugs proven to work. Some drugs have been; others have been shown to cause harm. "right drug, right dose, right route."

The same is true for medical software. We need to speak in specifics about specific software. In the referenced study, the specific software was not reported, only that it was commercially available from Cerner. On Cerner's website, I find 8 different products listed under "Cerner CPOE solutions." Are they all great? Are most of them great, but one is dangerous? Are Cerner's product just as good as anothers or does Cerner's decrease mortality while Epic Systems increases it?

If we continue to talk in generics, companies will continue to market "me too" products based on the "fact" that CPOE is good for XYZ reason. When people use these systems and have negative outcomes, the whole system will get blamed. Worse, patients will be hurt on untested systems.

Selfishly, I hope we move to specifics soon, so I will have more data with which to decide which systems to buy.

Disclaimer: I have no financial or professional interest in any company involved in making healthcare IT products.